Early Ambulation After Diagnostic Heart Catheterization

Abstract

The general recommended strategy after arterial invasive procedures is a 4- to 6-hour bed rest that is associated with patient discomfort and increased medical costs. We hypothesized that mobilization of selected patients at the second hour would not increase vascular complications. Coronary angiography was performed through the femoral route via 6-Fr catheters. Homeostasis was achieved by manual compression and maintained with a compressive bandage. A total of 1,446 patients were ambulated at the second hour and 1,226 of them were discharged without complication. A total of 220 patients required further follow-up due to blood oozing; 154 patients were conventionally ambulated due to difficult arterial access, longer (>15 minutes) compression time, hematoma formation within 2 hours, or hypertensive state (blood pressure >180/100 mm Hg). Twenty-five (16%) of those patients developed minor bleeding after ambulation. No major bleeding or large hematoma was observed during in-hospital observation. Ecchymosis (10% [2-hour group] vs 21% [4-5 hour group]) and small hematomas (22% vs 9%) were the most frequent complications after discharge. Early mobilization of selected patients undergoing diagnostic heart catheterization through the femoral artery via 6-Fr catheters is safe and associated with acceptable bleeding complication rates.

Effect of early ambulation after transfemoral cardiac catheterization in Hong Kong: A single-blinded randomized controlled trial

“…Femoral artery is commonly used in daily cardiologic practice because of its larger diameter (3)(4)(5). However, the invasive transfemoral puncture approach can simultaneously incurs the risk of vascular complications, such as bleeding, hematoma at the puncture site, distal embolization and arterial thrombosis (6,7).…”

“…To relieve these discomforts caused by prolonged bed rest, early ambulation has been proposed and its effectiveness has also been examined by various studies (3,4,12,(15)(16)(17). The suggested early ambulation from these studies ranges from 1 hour to 6 hours with the sheath size from French 5 to 8.…”

“…The suggested early ambulation from these studies ranges from 1 hour to 6 hours with the sheath size from French 5 to 8. It has shown that the suggested time for early ambulation in different studies is safe and associated with low rates of vascular complications (3,4,12,(15)(16)(17), higher satisfaction (12) and less back pain (3,12). It is believed that early ambulation can improve patients' outcomes, decrease the workload of nursing staff and length of stay in hospital, which accordingly reduce the health care costs (12).…”

Repouso de três horas não aumenta complicações após cateterismo cardíaco diagnóstico com introdutor arterial 6 F: ensaio clínico randomizado

“…Boztosun et al 6 avaliaram 1.446 pacientes submetidos a cateterismo cardíaco diagnóstico com introdutor arterial 6 F, dos quais 1.226 (85%) deambularam em duas horas e foram liberados, e o restante, que apresentou alguma intercorrência (dificuldade de acesso arterial, hipertensão não-controlada, compressão prolongada, etc. ), permaneceu por duas a três horas adicionais em observação.…”

“…), permaneceu por duas a três horas adicionais em observação. Nenhum sangramento maior ou grande hematoma foi notado durante a observação hospitalar, à exceção de equimoses (10% vs. 21%, respectivamente, para o grupo com deambulação em duas horas e para o grupo com deambulação mais demorada) e pequenos hematomas (22% vs. 9%, respectivamente, para o grupo com deambulação em duas horas e para o grupo com deambulação mais demorada) após a alta, levando os autores a concluir que a deambulação precoce é segura e cursa com taxa aceitável de complicações hemorrágicas 6 .…”